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Remember the old phrase ‘be careful what you ask for, you just might get it?’ Well, Anthem Blue Cross put out an email yesterday to agents advising us that due to the new changes resulting from the Patient Protection and Affordable Care Act (PPACA), also known as health care reform, if you are looking for an individual plan with them you have until September 22. After that, they will have to update their plans, their software (and presumably our software, those of us who have their own quoting sites) with the new plans and rates that will be effective September 23.

Now, before you go as nuts as a Jet Blue flight attendant (gotta love that guy!) think about doing something sooner rather than later. Right now, we know what the plans are and we know what the rates are. Anthem currently offers a 12 month rate guarantee, so whatever you enroll in now, you will maintain that rate for 12 months. Since we don’t know what is coming, I’d vote for a bird in the hand.

Carriers are going to be required to include certain benefits and that will probably raise rates. And it’s not only going to be Anthem, all carriers are most likely going to be doing something in order to comply with the new law. This is just the first we are really hearing about it. Why am I fairly sure rates will go up? Two things in particular–people under age 19 will no longer have pre-existing conditions held against them, and there will no longer be annual or life time maximums allowed on plans. The latter frankly won’t have a huge affect overall. Most plans in California have anywhere from a $3-$7 million life time maximum, which the vast majority of us will never come near. But, it will be a reason to increase rates in anticipation. The scarier part will be what happens when they have to take all applicants.

Basically, this is just the beginning of sweeping change. We’re trying to keep up, but since so much of this was not worked out at the time the bills were passed, and still hasn’t been, it’s time to hang tight and hope for the best.

There have been a couple of articles the past couple of days about the Pre-existing Condition Insurance Plans (PCIP) that are being set up in Michigan and New York. You might want to check these out as they will be an example of things to come. Michigan’s PCIP plan and New York’s PCIP plan, called the Bridge Plan.

New York has received just short of $300 million and Michigan $141 million of the $5 billion set up by the federal government to put this into action. None of the articles I’ve read on this in general have talked about how much the cost is going to be to the people who can’t qualify for insurance on their own, but the word ‘subsidy’ in many forms have been used is all of them.

What about California? Well, we’re not quite there yet. There is proposed legislation AB 1602, that is meant to set up an exchange, but there are some definite flaws and the insurance industry in CA is trying to mount opposition. We want to see changes too, that’s not the problem. We just need the right changes.

First, there is no ‘open meeting’ provision, minimal to no regulatory oversight and with a $30 million budget being proposed, you want some sort of oversight, come on! Additionally, it presses for standardization of plans being offered, meaning there could be as few as 10 plans offered. And because some would be HMO type plans and those aren’t always available in rural areas, there could be fewer than 10 plans.

As an agent, the requests I get for plans really vary. Some want high deductibles of $5,000-$10,000 and others don’t want anything higher than $500-$1000. Some want HMOs, some want PPOs. Not all doctors are contracted with all plans, so then what do you do? You want to avoid seeing non contracted doctors when possible because the coverage from your insurance carrier is lower.

There are many other details in this, but basically it is just not a well written bill. There needs to be a larger selection/variety of plans, and let the free market sort it out. When insurance carriers introduce plans that don’t sell well, they stop offering them. And the thought of a government entity running a ‘new’ program with minimal to no oversight, uh, yeah, right.

We already have a budget problem in this state, and theoretically someone’s watching. Let’s not let this spread…..

Okay, I realized today that I’ve evolved into the ultimate insurance nerd. A few of weeks ago I subscribed to a service with the California Department of Insurance (CDI) where I can receive certain updates as they come in. Previously I got things on licensing requirements, you know, the usual professional stuff.

But now I’m getting information on when insurance carriers file their new rates for ‘approval’ with the CDI. This isn’t easy stuff to read, so if you’re having a bout of insomnia one evening, you might consider checking out rate increase information as it is submitted.

So I started out with Aetna, and wasn’t going to be deterred by the fact that it was 93 pages. What you will see if you check this stuff out is what’s being proposed for new business rates quarter by quarter. Aetna and most other carriers have a 12 month rate guarantee so your rates don’t go up right away but as you all know they do go up at least once a year. But reading all that is taken into consideration, hhhmmmm. I knew the basics but looking at this was a bit daunting.

Then I decided to check out Anthem–their latest filing was 386 pages. But that’s because they have a billion plans and a somewhat convoluted way of assembling their rate sheets. But I went through it all anyway, looking to see what would potentially be happening with my rates once my guarantee expires. I’m not thrilled. If it read it right, it will be going up about $50/month.

You have to know that all carriers in our area are going to have to be doing something in order to comply with the new health care reform bills. And that is listed in these filings as a reason for the rates; no more lifetime maximums, preventive services covered with no cost sharing, no limits on complex radiology and lab tests, and so on. These are all going to add to their costs, once people catch on to particularly the preventive services piece. Check out what is being included in the preventive services arena.

My advice? Not only are rates going up, but many plans will be changing as well. If you are in the market for an individual/family plan, get rolling on it ASAP so you can take advantage of the carriers that offer a 12 month rate guarantee.

The news came out last week that Leslie Margolin was leaving Anthem Blue Cross and I had to wonder why. Of course, there’s the obvious, the blow out earlier this year when the rate increase craziness hit. But that was months ago, and things had toned down considerably. Click here for a short story on this.

I heard her speak at a forum earlier this year in Woodland Hills, and she seemed like a very nice, nose to the grindstone kind of person. In asking my account rep at Anthem about here, he commented that people would be surprised at how geared toward a desire to provide a more universal type of health care she was.

Let’s face it, NO ONE was going to win in the position she was in. She did diversify the product portfolio considerably in her time there, which makes me wish some of the other carriers would do a bit of that too. While overall I like what they’ve done, I like to have more than one carrier to chose from and when their pricing beats everyone out overall, there’s not a lot to suggest outside of Anthem. People these days have to watch their budgets. I regularly have account execs tell me I should be selling on the benefits of a plan, not just the price. I do that to an extent, but if you have two similar plans, one $100/month less than the other, that’s usually the only benefit most folks want to look at. And I can’t blame them.

I hope Ms. Margolin does well at her new job, and would love to pick her brain one of these days on this whole mess!

I came across an article last month that was published by USA Today on April 30th that to me, outlines just a part of the big wake up call we have coming in 2014 when the bulk of the health care reform measures go into effect. If you can find it, check out the article by Sandra Block, “IRS lack clout to enforce mandatory health insurance.” Sorry, I waited to long to post this and lost the link. But my article will give you the basis for my concern.

This article lists estimates of needing 16,000+ IRS agents to enforce this eventually. The Congressional Budget Office is estimating the cost at $5-10 billion to administer this. And that’s just the start.

My concern along with other agents in California is the price tag on all the changes. Even though people aren’t happy with rates in LA and Ventura counties, you are definitely paying less than places like Massachussettes, New York and New Jersey. And now that you are looking at eventually subsidizing people, not excluding for pre-existing conditions, rates will soar. But the IRS can’t apparently enforce these new provisions in the law.

For example–30 year old male in New York City, hospital only plan would run $176/month. No deductible, but no coverage for office visits, most outpatient care or prescriptions. Which is more of what a 30 year old would need. You could get something comparable in the SFV area for $78-99/month, but there would be a deductible.

The same 30 year old, wanting a more comprehensive plan, opts for a $2000 deductible, $30 office visits, 80/20 coverage, sounds great right? Are you willing to pay $529.06/month for that? That’s a real figure for the 10009 zip code. I can find $2500 deductible, 70/30 plans with three office visits per year with generic and brand coverage for $111/month.

So you might want to look for coverage now, while it’s affordable in California. No one really knows what will happen once all this starts to kick in. Pretty scary!